Provider Demographics
NPI:1174543441
Name:BARON, JACK E (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:E
Last Name:BARON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:941-841-4201
Practice Address - Street 1:3000 S MCCALL RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-8616
Practice Address - Country:US
Practice Address - Phone:941-406-9029
Practice Address - Fax:941-406-9028
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME38100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08105OtherBCBS
FLD51985Medicare UPIN
FL08105OtherBCBS